Minnesota
Department of
Health
PUBLIC HEALTH
LABORATORY
Fiscal Year 2012
Annual Report
mIssIon
Protecting, maintaining, and improving the health of all Minnesotans
A
sciencewe use the best
scientific data and
methods available
to promote
healthy living
Integritywe strive to
achieve the best
public health
outcomes
Value
statements
Respectwe encourage
listening
to and
understanding
our differences
Collaborationwe value diversity
and contributions
from employees
and partners
VIsIon
Keeping ALL Minnesotans healthy
2012
CONTENTS
1 message from the Director
Message and updates from Joanne Bartkus, Ph.D.
PHL’s impact and sneak peek into next year’s report
PHL
Annual
Report
p. 3
3 newborn screening Program
New legislation and new program features
Midwives start offering newborn hearing screening
“Bubble Boy Disease” added to newborn screening panel
6 environmental laboratory
What’s in your water?
Protecting Minnesota wild rice
Study: metal concentrations in newborn blood
p. 6
9 Infectious Disease laboratory
Identifying antibiotic resistance
How are flu strains identified and chosen for vaccines?
Salmonella outbreak in Minnesota from organic eggs
12 environmental laboratory
accreditation Program
Exemptions for those with permits
Workgroups improving compliance materials and tools
New bill allowing advisory inspections
p. 9
13 Preparedness & emergency Response
First case of inhalation anthrax in Minnesota
Can PHL identify a chemical it has never tested for before?
Trainings for suspicious and unidentified samples
16 laboratory Happenings & Budget
Fiscal Year 2012 budget and a look back at past budgets
Awards received by PHL this fiscal year
Photo Credits
Cover: Minnesota Department of Health (MDH) Inside Cover: MDH table of Contents: Texas Department of State Health Services; MDH; CDC/
Erskine. L. Palmer, Ph.D.; M. L. Martin Page 1: MDH Page 3: MDH Page 4: NASA Johnson Space Center Page 5: MDH Page 6: MDH
Page 7: Minnesota Pollution Control Agency Page 8: MDH Page 9: CDC Page 11: CDC/ Debora Cartagena Page 12: NordNordWest
Page 13: MDH Page 14: Rob Hille
Message from the Director
Dear Reader,
It is my pleasure to present to you the third annual report from the Minnesota Department of Health,
Public Health Laboratory (PHL). This report presents the laboratory highlights for Fiscal Year 2012 (FY12:
July 1, 2011-June 30, 2012), which range from details surrounding the investigation of a case of inhalation
anthrax to an interview with a young man whose life is a testament to the value of newborn screening. It
also covers our activities to protect Minnesota’s treasured environmental resources.
In my introduction to last year’s report, I mentioned the challenges in preparing for the potential
interruption of services due to a state shutdown. Sadly, on July 1, 2011, this became a reality, and we had
to implement shutdown plans. The shutdown lasted three tense weeks during which the laboratory was
allowed only to perform those functions deemed essential by the Governor and approved by the court.
While we consider all of our laboratory services to be essential, we were only able to continue those
services that met the criteria set out by Governor Dayton in his letter to state employees, in other words,
those functions “so critical to protecting the lives and safety of the people of Minnesota…they should be
made exceptions to the (state) Constitution’s clear prohibition”. Many state employees, including more than
half of the PHL staff, were laid off during the shutdown and the agency implemented an incident command
system to monitor activities and to supply employees with critical information. In the laboratory, we held
daily meetings to provide staff with updates and to check-in with employees about whether or not we
had adequate staffing to perform critical activities. This was a challenging time; however, PHL staff, both
those who were working and those who were laid off, rose to the challenge. Once the shutdown ended, we
sincerely welcomed our colleagues back and everyone quickly got to work to clear the backlog of testing. I
am constantly grateful for the resilience, dedication, and professionalism of our employees that enabled us
to recover from this disruptive event.
If you have read our previous reports, you will notice our exciting new report format. We are
experimenting with the use of infographics to improve the look and readability of our report. We hope
you will like it, and we welcome any feedback you are willing to provide. My thanks to Patti Constant for
her dedicated and expert leadership of the annual report project and to Sondra Rosendahl, who used a
previously hidden (to me) talent for graphic design to convert
the report into the new format, while continuing to perform her
“day job” as a dedicated genetic counselor.
So, I invite you to read more about the important work our
laboratory does to help us meet our agency mission to protect,
maintain, and improve the health of all Minnesotans.
Joanne Bartkus, Ph.D.
Public Health Laboratory Director
1
2012 MDH PHL ANNUAL REPORT
PHL’s Impact on
Minnesota Families
During FY12
Newborn Screening Program
Impact: Infants diagnosed with
one of the conditions on the
newborn screening panel
Environmental Laboratory
Impact: Samples analyzed for
contaminants in the water, soil,
and air
Infectious Disease Laboratory
Impact: Clinical tests for
infectious disease trends and
disease outbreaks
Environmental Laboratory
Accreditation Program
Impact: Environmental
laboratories accredited to the
national standard
2012 MDH PHL ANNUAL REPORT
413
40,893
44,450
Sneak Peek:
Topics Covered
in Next Year’s
Report!
Newborn Screening Program
Screening for Severe
Combined Immunodeficiency
Critical Congenital Heart
Defects added to the panel
Boost in hearing screens
from out-of-hospital births
Environmental Laboratory
Response to Northeast
Minnesota’s record flooding
Contaminants of
emerging concern - new efforts
The Infant Development
and Environment Study results
131
Infectious Disease Laboratory
Swine flu at the State Fair
PHL chosen to be a
Vaccine Preventable Disease
Reference Laboratory
2
N
Overview:
The newborn Screening Program screens infants at
birth for over 50 serious health conditions. Blood
spots collected from the infant’s heel at the birth
hospital are sent to the PhL for testing. newborn
screening detects these hidden, rare conditions before
symptoms appear so affected infants can receive
prompt treatment to prevent severe health problems
or even death. minnesota newborns are also screened
for hearing loss, which, if left unrecognized, could
lead to speech and language delays.
Almost every day, the newborn Screening
Program identifies an infant with one of these
A
B
or
health conditions. Last year, 413 children were
diagnosed with one of the conditions on the
newborn screening panel.
Newborn Screening FY12 Data
Births Registered
68,021
Infants Screened
67,002
Specimens Tested
69,901
Infants with blood spot disorders
146
Infants with hearing loss
267
The above data was calculated based on the date
the sample was received, not by birth year.
C
or
Q: Which of these infants has a serious health condition identified by newborn screening?
A: See green box on page 5.
New Legislation Changes:
In may 2012, Governor dayton signed legislation
impacting the newborn Screening Program. The new
legislation helps ensure that all minnesota infants
have the healthiest start possible. By keeping newborn
screening mandatory, it ensures parents receive early
education about newborn screening and provides
parents with new options. The table to the right lists
the specific changes the new legislation made to the
newborn Screening Program.
3
New Features of Newborn Screening
Prenatal education
Better education in the nursery
Leftover blood spots are kept for 71 days if all
test results are negative
Leftover blood spots are kept for two years if a
result is positive
test results are kept for two years for all results
Parents have option to request long-term
storage of blood spots after testing
2012 mdh PHL Annual Report
Out-of-Hospital Births:
Nationally, homebirth rates rose nearly 30% since 2004. In Minnesota,
homebirths now account for about one out of every 139 births.
To make sure these infants get the same care as those born in hospitals,
the Newborn Screening Program began an outreach effort to help
midwives perform newborn hearing screening. Though many midwives
already collect blood spots for screening, none had the equipment
or training necessary to conduct newborn hearing screening. Grant
funding from the Health Resources and Services Administration
(HRSA) provided eleven hearing screening machines to the Minnesota
Council of Certified Professional Midwives (MCCPM). The Council
distributed the equipment to licensed midwives statewide. Any midwife
conducting hearing screenings attended a required training session from
an audiologist and were assisted in developing and implementing policies
and procedures for newborn hearing screening.
In addition, education materials were created specifically for families
planning births outside of hospitals. More information can be found on
the Minnesota Midwives website at: http://www.minnesotamidwives.org/
Newborn_Hearing_Screening.html.
Screening for Severe Combined Immunodeficiency (SCID):
The Commissioner of Health accepted the recommendation of the Newborn
Screening Advisory Committee to add SCID (also known as “Bubble Boy
Disease”) to the newborn screening panel. The world was introduced to SCID
during the 1970s and 80s with the story of David Vetter (pictured below), a boy
with SCID, who lived for 12 years in a plastic, germ-free bubble.
Infants with SCID are born without an immune system; making them
vulnerable to infections that become serious and often life-threatening. These
children no longer need to live in bubbles because bone marrow transplants
are now available. If infants with SCID receive a
successful bone marrow transplant before three
months of age or before a serious infection, they
can lead healthy, normal lives.
Did you
Know?
Educational Outreach:
Prenatal Education
Nationwide, parental
education about newborn
screening usually occurs
in the hospital after
delivery. Many national
organizations have
suggested that education
about newborn screening
would be more effective
in the prenatal period.
Parent focus groups have
shown that expectant
parents want to learn very
basic information about
newborn screening before
they deliver.
Minnesota has worked to
become one of the first
states with a prenatalfocused education plan
- complete with a new
prenatal brochure, prenatal
provider information
folder, and a prenatal
education website. For
more information, see:
http://www.health.state.
mn.us/newbornscreening/
prenatal.html.
Only through newborn screening will diagnosis
and treatment for SCID be available early enough
to give affected children a chance for a healthy life.
2012 MDH PHL ANNUAL REPORT
4
Newborn
Screening
Program
Q& A
Evan Hromada
18-year-old with Galactosemia
Evan recently graduated from Edina High School. You wouldn’t know it by looking at him, but Evan has
Galactosemia. A person with Galactosemia is unable to fully break down galactose (a sugar found in milk),
which results in a dangerous accumulation that damages the liver, brain, kidneys, and eyes if left untreated.
*Go to http://www.health.state.mn.us/
newbornscreening/evan.html to listen to the
full interview.
is your experience with
1 What
newborn screening?
Newborn screening saved
my life. I was diagnosed with
Galactosemia when I was just
three days old, which prevented
long term health issues and a
potential for death.
have your experiences
2 How
with Galactosemia been?
I have learned a lot; most of all, I
have learned that everyone faces
adversity and that most of the
time it is not something that can
be seen.
Answer: B
parents learn their
5 When
baby has a problem like
would your life have
3 How
been different without
newborn screening?
If I wasn’t diagnosed as early as
I was, it would have been very
likely that I would have died or
that I would have faced severe
set-backs to my health.
Galactosemia, they are often scared.
What do you want them to know?
The first thing I would tell them in
all cases is that everything is going
to be all right. I would tell them
that these disorders are treatable
and that newborn screening caught
this disorder early enough so that
everything should be fine.
do you have to do
4 What
differently because you have
Galactosemia?
The few things I have to do
differently is that I have to take
calcium supplements, I have to
avoid dairy and check ingredients
to see what I can eat, and I have
to go to the U of M once every six
months to test the galactose levels
in my blood.
are doing so well. What
6 You
are your plans for the future?
I am going to Marquette next
year and plan to study business
and hope to study political
science also. I will say that I will
always consider activism for the
issues that are important to me,
especially newborn screening.
1 in 30,000 chance becomes reality for one family
In 2008, Everett Olson came into the world. Everett’s mom, Korissa,
initially declined newborn screening. After hospital nurses discussed the
importance of testing, she agreed to it. Four days later, the Olsons were
told by their son’s pediatrician that the newborn screen was positive for
Galactosemia. Though Everett had seemed fine his first few days of life,
he became very lethargic and jaundiced. Because of newborn screening,
Everett was treated right away. Today, Everett is a happy and healthy
4-year-old. His story was recently featured in a video produced by the
Save Babies Through Screening Foundation. View the clip at http://www.
youtube.com/watch?v=Q7oEz6pmhPA.
5
2012 MDH PHL ANNUAL REPORT
Environmental Laboratory
Overview:
The Environmental Laboratory
analyzes a wide range of chemicals.
Some of these chemicals occur
naturally while others do not. The
data generated is used by several
state partners [Environmental
Health, Minnesota Pollution
Control Agency (MPCA),
Department of Transportation]
and multiple counties to help
protect the public’s health. The
Environmental Laboratory is
also involved with developing
new methods for detecting
contaminants of emerging concern
at the federal and state level.
As technology has improved,
so has the ability to identify
various contaminants present in
our environment that we could
not previously detect. These
advancements allow for additional
information to be gathered that
may affect future environmental
and public health decisions.
Environmental
Laboratory
Testing Means:
Reassurancethat water is
safe to drink
and natural
resources are
protected
Results - to aid
decision making
by many state,
public, and
environmental
health programs
Quality - by
using standard
methods and
written operating
procedures
Answers - to
questions
about mercury
in newborns
Scientific
Expertise - of
40 scientists
dedicated to
accurate and
efficient sample
handling and
analysis
Emergency Preparedness
& Response - to incidents
involving chemical or
radiological release
What’s in Your Water?
On a daily basis the Environmental Laboratory receives hundreds of water samples from around the state
of Minnesota. In 2011 alone, we received 40,893 samples and ran 131,339 analyses. We are a full service
laboratory that can analyze water, air, blood, urine, milk, and cattle feed. But our bread and butter is water, and
why not? We are the “Land of 10,000 Lakes.” The people of
Minnesota love their lakes and of course, drinking clean
water. The Environmental Laboratory is here to help make
sure Minnesotans feel confident about their water.
Which glass would you drink?
2012 MDH PHL ANNUAL REPORT
The public generally knows that drinking cups of surface
water is not safe unless it has been treated. However,
just looking at, tasting, or smelling a glass of ‘clear’
water cannot tell you if contaminants are present or not.
Laboratory testing of our water is the only way to make
an accurate determination of the water quality, and we are
here to do just that.
6
Environmental
Laboratory
Protecting Minnesota
Wild Rice:
The Environmental Laboratory participates in
research projects with various state partners. In late
2011, we were presented with an exciting project
with the MPCA, funded by the Legacy Amendment
Clean Water Fund. MPCA staff were interested
in partnering to analyze nutrients and metals to
gather information needed for setting a new sulfate
standard to protect wild rice growth.
The study will try to determine the potential
negative effects of sulfide production in the root
zone of wild rice beds. If the biogeochemical
model holds, then future sulfate standards could
link surface water sulfate concentrations to the
production of sulfide in porewater (the water
occupying the spaces between sediment particles),
thus ensuring the surface water standard is
protective of wild rice.
The study is a collaborative effort among several
state organizations, including the University of
Minnesota, University of Minnesota at Duluth,
Science Museum of Minnesota, MPCA, and the
MDH Environmental Laboratory. This unique
opportunity allows us to perform comparison
studies, work with field and University staff, and
develop new laboratory methods in an area that
typically does not perform method development.
With a small capital investment and about two
months of method development, we were able to
get the new methods up and running and prepare
other methods to detect lower concentrations. As an
added benefit, one of the new methods allowed us
to increase our efficiency on the routinely requested
phosphate analysis. In June 2012, we received our
first samples for this project. We will continue to
analyze surface water, porewater, and sediment
collected for Sulfate, Sulfide, nutrients, and metals
for the next two summers.
7
2012 MDH PHL ANNUAL REPORT
The Pregnancy and Newborn
Exposure Study:
A group of Environmental Laboratory staff began a new
project in partnership with a national study called The Infant
Development and Environmental Study (TIDES); (http://
www.urmc.rochester.edu/ob-gyn/research/TIDES.cfm).
The Pregnancy and Newborn Exposure Study (PNES) is
a subset of this research and is being conducted at a clinic
in Minneapolis participating in TIDES. Samples from the
PNES will be analyzed by Environmental Laboratory staff for
mercury, cadmium, and lead. Samples will include newborn
blood spots (tested for mercury only) and umbilical cord
blood. This project will allow researchers to correlate
metal concentration in cord blood to the newborn’s blood.
Participation in the PNES is completely voluntary, requires
consent, and only includes women who are already involved
in TIDES who deliver their baby at designated hospitals. We
have begun receiving samples and will continue to receive
and analyze samples through the end of 2012.
Tough Times Call for Tough Decisions:
The beginning of FY12 did not start off well due to the state shutdown. After three weeks of keeping only
the most critical water testing activities going, the state budget was passed and the entire laboratory was able
to return to work. With this service disruption behind us, we had hard business decisions to make in order
to provide quality data while working within our budget.
Many factors made our tasks more difficult and more expensive. We saw an increase in legal disputes
and new agency initiatives. We strove to find a balance between meeting both national standards and our
clients’ needs. And of course, we have the constant challenge of providing the highest quality data available.
Increased quality comes at a cost and when we
evaluate the return on investment, sometimes we are
unable to continue offering certain analytical services.
In spring 2012, we announced that we were no
longer able to provide analytical services to our
partner of more than 30 years, the Department of
Labor and Industry. We had been the industrial
hygiene laboratory for the State. However, with
fewer incoming samples and aging instrumentation,
we were unable to financially justify continuing to
provide the service. It was an unfortunate decision,
but we need to balance an efficient use of resources
while maintaining quality work.
2012 MDH PHL ANNUAL REPORT
8
Infectious Disease Laboratory
Overview:
The Clinical Laboratory
recently changed its name to the
Infectious Disease Laboratory
(IDL). The IDL performs
diagnostic, characterization,
and surveillance testing of
infectious diseases recognized
for public health importance.
The testing categories
represented on the right
contribute to Minnesota’s (and
the nation’s) infectious disease
prevention and control. A total
of 44,450 tests were performed
by the IDL in FY12.
FY12 Specimen Testing Totals by Testing Type
Fungi
Serology
Rabies
Other Viral Infections
Food/Waterborne Infections
Other Bacterial Infections
Tuberculosis
Sexually Transmitted Infections
0
2,000
4,000
6,000
8,000
10,000
12,000
Identifying Antibiotic Resistance:
Alarmingly, infections caused by antibiotic resistant bacteria are on the rise worldwide, often spreading
through healthcare settings. Our ability to rapidly and accurately detect and identify these bacteria is crucial
to controlling and preventing infections. Swift identification and urgent reporting also assist health care
professionals in caring for patients.
Two of the most serious antibiotic resistance mechanisms are Klebsiella pneumonia carbapenemase (KPC)
and New Dehli metallobetalactamase (NDM). Bacteria with KPC or NDM resistance mechanisms are
untreatable by nearly all antibiotics currently available. The IDL performs tests to detect these and other
forms of antibiotic resistance.
In 2011, bacteria with KPC were identified in 21 patients
throughout Minnesota, which is relatively low compared
to other regions in the United States. Bacteria that carry
NDM are usually related to receiving medical care abroad
and are rarer than KPC; only two patients have been
identified in Minnesota since 2011.
The IDL has been instrumental in establishing
collaborative surveillance with our MDH Healthcare
Associated Infections (HAI) group, hospital laboratories,
and infectious disease specialists statewide. The
surveillance benefits local communities by keeping an
eye on bacteria of emerging public health concern and
protecting the health of all Minnesotans.
9
2012 MDH PHL ANNUAL REPORT
The Infectious
Disease
Laboratory...
supports the prevention and
control of diseases of public
health significance by:
1
Performing tests on
patient specimens to
determine the presence
or absence of diseasecausing agents
Impact of the Influenza
Surveillance System:
2
3
Characterizing
agents submitted
by other
laboratories
Testing in
response to
public health
emergencies
The IDL influenza surveillance system is designed
to track flu activity from around the state and detect
novel flu strains. Clinical laboratories throughout
Minnesota participate in virologic surveillance by
sending specimens for flu detection and further
viral characterization to the IDL. Symptoms of other
respiratory illnesses are very similar to flu. Therefore,
specific identification of circulating respiratory
viruses is advantageous for patient treatment,
clinician awareness, and public health intervention.
Minnesota virologic surveillance uses a combination
of molecular and classical virology techniques that
MDH
Website
& MLS
Minnesota
Virologic
Surveillance
MDH-IDL
•Identification
•Characterization
•Vaccine Matching
WHO
CDC
2012 MDH PHL ANNUAL REPORT
4
5
Training and
consulting with
other laboratory,
medical, and
public health
colleagues
Participating in
applied research such
as laboratory method
development
allow a large number of specimens to be screened,
provides quick turnaround time, and increases
the likelihood that unidentified viruses will be
accurately detected. The IDL is becoming one of
only a handful of laboratories that continue to use
hemagglutination inhibition detection as the only
method for determining if current circulating
flu strains are those covered in the recent flu
vaccine. As a result, the data generated from the
Minnesota virologic surveillance and other state
public health laboratories substantially impacts
what strains the Centers for Disease Control
(CDC) and the World Health Organization
(WHO) use for future vaccines.
Minnesota virologic surveillance provides rapid
communication of results statewide. Local flu
surveillance data is communicated through the
MDH website and the Minnesota Laboratory
System (MLS) computer network, an outreach
program to healthcare providers. Healthcare
professionals are able to use this information to
make important decisions for patient care. The
IDL flu surveillance system acquires, analyzes, and
produces results that enable local communities to
respond to the unpredictability of flu season.
10
Infectious
Disease
Laboratory
Case Story:
In August 2011, three specimens arrived at the IDL that tested
positive for the foodborne bacterium Salmonella Enteritidis. DNA
fingerprinting revealed that all three had the same fingerprint
pattern, SE1B173, which had never been seen before in Minnesota.
The MDH Infectious Disease Epidemiology, Prevention and
Control (IDEPC) Division interviewed each of the three case
patients using a 12-page food consumption interview form but no
link to any common food source was found.
A month later, two more specimens were identified with the same
SE1B173 pattern. Using sophisticated interview questionnaires and re-interviewing previous cases, the
IDEPC found that all five cases reported high egg consumption, with two cases mentioning organic
eggs specifically. On October 7, the IDEPC launched an investigation. The Minnesota Department
of Agriculture (MDA) was notified and proceeded to conduct a trace-back investigation on the eggs.
Within seven days, MDA linked egg Company A as being the supplier to the grocery stores where the
eggs had been purchased. Further study demonstrated that consuming organic eggs from Company
A was statistically associated with illness. On October 14, MDA inspectors visited Company A’s farm
and sampled the barn and processing areas. The samples were positive for Salmonella contamination,
which prompted Company A to issue a voluntary recall of all eggs packed at the farm. Grocery stores,
food wholesalers, restaurants, and foodservice companies in Minnesota, Wisconsin, and Michigan were
urgently made aware of the risks of these eggs. MDA and MDH issued a joint press release notifying the
public of the outbreak and subsequent recall.
Company A depopulated their farm, thoroughly cleaned the environment, and ultimately tested
negative for Salmonella before egg production resumed. The combination of in-depth food consumption
questionnaires, the use of DNA fingerprinting techniques, and the interagency communication between
MDH and MDA worked to solve the outbreak, which ultimately stopped the source of contamination
and prevented further human disease.
Other FY12
Foodborne
Outbreaks
Investigated
in Minnesota
11
Pathogen
Campylobacter coli
Salmonella Enteritidis
Salmonella Typhimurium
E. coli O157
E. coli O157 and
Cryptosporidium parvum
Enteroaggregative E. coli
Group A Streptococcus
Campylobacter jejuni
Food
Raw Milk
Eggs
Watermelon
Prepackaged Salad;
Romaine Lettuce
Unpasteurized
Apple Cider
Black Forest Ham
Cooked Pasta
Raw Milk
2012 MDH PHL ANNUAL REPORT
Environmental Laboratory
Accreditation Program
16
Overview:
The Minnesota Environmental Laboratory Accreditation Program
(MN-ELAP) performs the following types of assessments:
• onsite
• application
• documentation review
• proficiency testing
131
New or revised procedures
MN-ELAP prepared for
conformance to the updated
national standards published by
The NELAC Institute (TNI)
Permit Requirements:
Environmental laboratories
accredited by MN-ELAP
Effective January 1, 2012, MN-ELAP started offering exemptions
from the national standard for quality control, personnel, and
the frequency of proficiency testing requirements for laboratories
analyzing samples for compliance with National Pollutant
Discharge Elimination System (NPDES) permits.
Workgroups:
MN-ELAP established a series of workgroups to
identify and prioritize improvements to compliance
assistance materials and tools. The workgroups are led
by Advisory Committee members or their designees.
Each workgroup, with membership drawn from across
interested parties, has been tasked with defining
the purpose of each workgroup and the resulting
deliverables. The workgroups were formed around the
products identified by the Advisory Committee, which
included the following:
• create and revise templates and forms related to
laboratory accreditation;
• revise and enhance the Environmental
Laboratory Data Online (ELDO) accreditation
system;
• compare the 2003 NELAC standard to the 2009
TNI Standard and review existing comparison
tool for usefulness; and
• develop data integrity and ethics training
resources and information.
66
Annual routine onsite
assessments conducted
by MN-ELAP
15
Recognized accreditation programs that
assess and accredit laboratories to the
requirements of the national standard
*
*
*
*
*
* **
*
*
*
**
*
*
Advisory Inspections:
The 2012 Minnesota Legislature passed bills allowing regulated entities in the
State of Minnesota to request an advisory inspection to comply with state laws.
The compliance assistance already provided by MN-ELAP meets this purpose.
2012 MDH PHL ANNUAL REPORT
12
Preparedness & Emergency Response
Overview:
The PHL plays a key role in training clinical microbiology laboratories on identification, notification, and
referral of potential agents of bioterrorism, such as Bacillus anthracis. The PHL is an active member of the
CDC Laboratory Response Network (LRN). This network provides training and outreach, and it develops
and maintains collaboration with external partners to aid in the rapid detection of biological and chemical
threats. PHL staff is qualified to perform analytical methods and provide training to sentinel laboratories
(clinical laboratories on the front lines of disease detection, see story on page 15) and first responders.
Preparedness Pays Off Anthrax in Minnesota:
On August 5, 2011, the PHL was notified by a sentinel laboratory
that they had grown a distinctive Bacillus species of bacteria
that causes anthrax disease. The patient, a 61-year-old man, was
admitted to the hospital the previous day with what appeared
to be pneumonia. The man had been vacationing in a number
of western states for the previous three weeks. The laboratory
that tested the culture had been trained in LRN procedures
by the PHL, so when they could not rule out anthrax, hospital
staff immediately notified the PHL of the isolate, and its rapid
transport to the PHL was arranged.
The Facts
* Anthrax is an infectious
disease acquired through
the skin, inhaled into the
lungs, or ingested from food.
* 115 sentinel laboratories
and 433 laboratorians in
Minnesota are trained to
recognize anthrax.
* 54 samples were tested
by PHL for the anthrax
investigation described on
this page.
The PHL used CDC LRN methods to confirm that the isolate was
indeed Bacillus anthracis. Anthrax is a disease that occurs naturally
in the U.S., but it can also be used as an agent of bioterrorism, as
happened in 2001 when letters containing anthrax spores were
sent through the U.S. Mail. The PHL sent the isolate to the CDC,
where it was determined that standard antibiotics could be used as
treatment and that it appeared to be a naturally occurring anthrax
bacillus and not related to bioterrorism.
To determine how the patient acquired anthrax, environmental
samples were tested. The PHL and the Minnesota National Guard
55th Civil Support Team (CST) collected samples from the patient’s
car, including rocks collected by the patient, elk antlers he purchased
at a roadside stand, and even parts of the car itself. All samples
tested negative for anthrax.
Although the source of the anthrax remains unknown, the LRN
trainings provided by PHL and the partnerships developed as a
result of the trainings, led to a rapid response. Fortunately, because
of early detection by the alert sentinel hospital and the efforts of
clinical, CDC, and MDH personnel, the patient responded to
treatment and survived his infection.
13
2012 MDH PHL ANNUAL REPORT
What if a mass
exposure event
occurs, and it is
not a chemical
the laboratory can
currently test for?
“Death Cap” Mushroom
Surge Exercise:
As a member of the Chemical Laboratory
Response Network (LRN-C), the PHL is
validated to test for over three dozen chemicals
in the blood or urine of patients that may have
been exposed to chemical warfare agents or
toxic industrial compounds.
The spring 2012 CDC surge capacity exercise
looked at the LRN-C’s top laboratories’ ability
to quickly incorporate new methodology and
begin processing patient samples for a chemical
not currently tested for. The scenario involved
over 14,000 victims exposed to the deadly
Amanita mushroom, otherwise known as the
“death cap” mushroom. The PHL performed
over 900 tests in just under 36 hours to validate
an analytical method on three instruments.
This was followed by analyzing over 518 patient
specimens. Patient sample results were reported
to the CDC in less than 63 hours from the start
of the exercise. This surge capacity exercise
demonstrates the robust yet flexible capability
of Minnesota’s LRN-C program.
March 28 at 05:29
CDC and public health
personnel collaborate to
identify causative agent
March 26 at 07:03
CDC responds to a
report of 674 cases
of nausea, vomiting,
and diarrhea
causing 25 deaths
April 6 at 11:16
CDC develops test
for amanitin toxin
in urine
March 30 at
09:38
Preliminary
analysis
suggests
Amanita
mushroom
toxin
2012 MDH PHL ANNUAL REPORT
April 12
Amanitin
standards
and patient
samples arrive
from the CDC
April 9
Instrument
supplies and
computer
based training
arrive from
the CDC
April 17 at 24:30
Three separate
instruments
completed
method
validation
using over 900
samples
April 16 at 12:00
Method
validation
begins (in
real scenario,
testing would
have occurred
immediately)
April 19 at 00:57
Final results
for over 500
patients
analyzed and
submitted to
the CDC
April 18 at 06:00
First group of
patient specimen
results transferred
to the CDC
14
Preparedness
& Emergency
Response
Suspicious Substance Sample
Collection and Hazards Screening
Training:
Our
Trainings
Span the
Entire
State!
Hazards Screening Training
HAZMAT teams trained
Individuals trained
Hours of training provided
The PHL is responsible for identifying suspicious substances
that could pose a threat to the public. Extreme precautions
must be taken when receiving these samples because many
substances are harmful even in very small quantities. To help
ensure the safety of staff and protect our laboratory facilities,
PHL implements safety measures prior to the sample’s arrival.
FY12 Data
14
303
100
Beginning in January 2012, PHL emergency preparedness
staff embarked on a training program with the state Chemical
Assessment Teams (CATs) and other hazardous materials
(HAZMAT) responders on procedures for safely collecting
field testing substances and transporting samples to the PHL
for testing. Field tests help the CAT and HAZMAT teams
screen for hazardous properties (e.g. radiation, explosiveness,
and corrosivity) that may pose a risk to the public, to the
first responders, and to laboratory staff. Proper sample
characterization and collection are critical elements for an
emergency responder to know.
Ready or Not: Is this Anthrax?
In May 2012, the PHL conducted an exercise to assess the testing and communication capabilities of the MLS
sentinel laboratories. Communication was tested by sending out a MLS Laboratory Alert to all of the sentinel
laboratories and response times were measured (See Table Below). To test their laboratory capabilities, one
sample was sent to each of the 115 advanced sentinel laboratories. Their task was to either “rule out” or refer
the isolate back to PHL. Overall; 91% of laboratories
performed some level of testing and reported their
results. Among those laboratories, 86% of them
correctly either ruled out or referred the isolate to
PHL for additional testing.
Data generated from this exercise will enable PHL to
target specific training and education to individual
facilities. The results will also guide efforts to more
accurately classify LRN sentinel laboratories based
on changes in laboratory practice and testing
capability. Communication practices will be
modified in response to specifically identified gaps in
existing policies, procedures, and systems to better
prepare laboratories for an actual emergency.
15
2012 MDH PHL ANNUAL REPORT
Laboratory Happenings & Budget
A LOOK
PHLBudget-ALookBack
atPastThreeFiscalYears
$25,000,000
at the
$17.58
Million
$20,000,000
Budget
BUDGET
$18.8
Million
$21.76
Million
$15,000,000
$10,000,000
$5,000,000
$0
BreakdownofBudgetby
FundCategoriesfromFY10-FY12
$8
Budget (millions)
2011
2012
Fiscal Year
Where
Do The
Funds
Come
From?
$7
$6
$5
$4
$3
$2
$1
$0
2010
State
Federal Restricted General Environment
Government
Misc.
and Natural
Special
Special
Resource
Revenue
Revenue
Fund Categories
For a description of fund categories, visit
http://www.health.state.mn.us/divs/phl/funds.html
For past annual reports and budgets, please go to
http://www.health.state.mn.us/divs/phl/pastreports.html
2012 MDH PHL ANNUAL REPORT
PHL
Awards
• BetsyEdhlundandJeffBrenner
fromtheEnvironmental
LaboratoryandPatMcCann
fromEnvironmentalHealthwon
theOutstandingPosterAward
atthe2012WinterConference
onPlasmaSpectrochemistry
fortheirposterentitled,
“DeterminationofTotal
MercuryinResidualDried
BloodspotsofNewbornsfrom
theLakeSuperiorBasinRegion
ofMinnesota,Wisconsin,and
Michigan.”
• StefanSaraviafromPreparedness
andEmergencyResponse
receivedthe“Outstanding
StateAgencyPartner”award
fromHomelandSecurityand
EmergencyManagementatthe
2012Governor’sConferencefor
thetrainingandoutreachhe’s
providedtothestate’schemical
assessmentteams.
• TheNewbornScreening
Programwonthe2012Early
HearingDetectionand
Intervention(EHDI)Websiteof
theYearAwardattheAnnual
EHDIMeetinginSt.Louis.
• InMay2012,theNewborn
ScreeningProgramwonthe
MinnesotaAssociationof
GovernmentCommunicators
AwardofExcellencefortheir
prenataleducationbrochure.
16
Minnesota
Department of Health
Public Health Laboratory
Mail
PO Box 64899
St. Paul, MN 55164-0899
Visitor
601 Robert Street N
St. Paul, MN 55155-2531
Phone
651-201-5200
http://www.health.state.mn.us/divs/phl/index.html
The 2012 PHL Annual Report is available at:
www.health.state.mn.us/divs/phl/annualreport2012.pdf
Scan here!
Use your smartphone and get the
PhL annual report at your fingertips.